Capecitabine/Oxaliplatin Combination Reduces Treatment Costs in Metastatic Colorectal Cancer

NEW HAVEN, Connecticut-An economic analysis comparing the costof treating metastatic colorectal cancerwith capecitabine (Xeloda) and oxaliplatin(Eloxatin) in combination (XELOX)vs the cost of using fluorouracil (5-FU),leucovorin, oxaliplatin (FOLFOX4) demonstrateda $4,613 per patient cost savingswith XELOX over a 6-month treatmentperiod.The results of the cost analysis werereported by Edward Chu, MD, professorof medicine and pharmacology, Yale UniversitySchool of Medicine, New Haven,Connecticut (ASCO abstract 1080).Two categories of direct costs were considered.The first category, chemotherapyacquisition plus administration costs perpatient, was $42,037 for XELOX vs $44,607for FOLFOX4. The increased drug acquisitioncost for XELOX ($41,144) comparedwith FOLFOX4 ($34,616) was more thanoffset by the large reduction in the drugadministration cost for XELOX ($893)compared with FOLFOX4 ($9,991). Thisresulted in a net reduction in the cost oftreatment administration of $2,570.Fewer Adverse EventsFor the second category, managementof adverse events, investigators determinedthat treatment-related adverse events requiringmedical intervention are twice aslikely with FOLFOX4 compared with XELOX(probability of treatment requirement:1.188 vs 0.540). The cost of managingadverse events is therefore substantiallyreduced for XELOX compared with FOLFOX4($405 vs $2,448) for a cost reductionof $2,043 per patient. This difference isprimarily driven by the higher rate of neutropeniaobserved with FOLFOX4.Results of a large phase II trial usingXELOX to treat metastatic colorectal cancer demonstrated a 55% response rate andfavorable safety data, with 7.6 months progression-free survival and 19.5 monthsoverall survival. These results are generallycomparable to the therapeutic profile ofFOLFOX, but the XELOX regimen has anadded advantage of convenience, requiringfewer days of hospitalization or clinictime for IV infusions."The oral administration of capecitabineenables chronic twice-daily dosing thatclosely mimics continuous infusion 5-FU.In the studies performed to date, the combination of capecitabine and oxaliplatin(XELOX) is at least as effective as FOLFOX4(oxaliplatin/5-FU/leucovorin) andhas a favorable safety profile," Dr. Chusaid.Most importantly, XELOX offers improvedconvenience over FOLFOX4 becausethe FOLFOX4 regimen requires bimonthlytreatments. In contrast, theXELOX regimen requires only a brief hospitalvisit once every 3 weeks."The cost benefit of XELOX would addto any gains in patient satisfaction due toits oral convenience, favorable safety profile,and/or indirect cost savings due to theextra clinic/travel time patients require forFOLFOX." Dr. Chu concluded. These projectionsare being further tested in ongoingrandomized trials.